Endobronchial Anaplastic Large Cell Lymphoma Masquerading As Endobronchial Aspergilloma

A. Bansal , A. Ganjoo , V. Malhotra , P. Kumar , T. Chand

Author address: 

Indraprastha Apollo Hospitals, New Delhi, India

Abstract: 

Introduction Endobronchial presentation of lymphoma is rare but more common in Hodgkins Lymphoma as compared to Non Hodgkins Lymphoma (NHL). Anaplastic Large Cell Lymphoma accounts for 2% of NHL and its endobronchial presentation is extremely rare. We are presenting a case which initially appeared to be endobronchial aspergilloma, another rare entity, on bronchoscopic biopsy but was proven to be Endobronchial Anaplastic Large Cell Lymphoma (EALCL) on surgical excision. Case Report A 24 years old Indian male, non smoker, presented with one month history of shortness of breath, dry cough and fever for two weeks. On physical examination patient was found to be thin built, air entry was diminished on right side of chest. The patient’s routine blood investigations were normal. His chest X-ray (Fig.1) showed right lower lobe collapse and hyperinflation of remaining right lung. CECT-thorax (Fig.1) revealed a soft tissue mass in right main bronchus with partially opened upper lobe and intermediate bronchus and collapse of posterior basal segment of RLL. Upper, middle and rest of lower lobe segments were preserved. Fibreoptic bronchoscopy revealed a yellowish glistening globular endobronchial mass in right main bronchus almost totally occluding it (Fig.2).The mass could be made to move while taking biopsies proving that it had a stalk. Histopathology revealed acute necrotizing inflammation due to aspergillus (Fig.2). Patient was put on intravenous voriconazole. In view of the large size of aspergillus mass, thoracotomy with right lower lobectomy and extraction of fungal mass from right main bronchus was done. The mass was found to be attached to the posterior wall of right lower lobe. Histopathology of the mass showed anaplastic large cell lymphoma in the stalk (positive staining with LCA, CD30 and Alk-1) and the head portion of the mass was again found to have aspergillus in necrotic material which was initially reported on bronchoscopic biopsy. There was no involvement of lung tissue by lymphoma. Discussion Treatment of choice for EALCL is chemotherapy, though this patient underwent surgical removal of mass due to its large size and initial diagnosis of endobronchial aspergilloma. EALCL requires surgical treatment only when they cause respiratory embarrassment due to obstruction and then it is mainly stenting or laser removal through rigid bronchoscope. Our case represents a rare case of EALCL whose head was covered with aspergillus probably from inhalation and this is the first case of its kind.
2011

abstract No: 

B103

Full conference title: 

American Thoracic Society
    • ATS 2011